Denosumab prevents acetabular bone loss around an uncemented cup: analysis of secondary outcomes in a randomized controlled trial.

Background And Purpose: Uncemented total hip arthroplasty (THA) is associated with periprosthetic bone loss. In a secondary outcome analysis from a randomized controlled trial, we studied whether denosumab can prevent loss of acetabular periprosthetic bone mineral density (pBMD) in patients who received a trabecular metal cup during uncemented THA.

Patients And Methods: 64 patients (aged 35-65 years) with unilateral osteoarthritis of the hip were randomized to 2 subcutaneous injections with denosumab or placebo, given 1-3 days post-surgery and 6 months post-surgery.

Management of bleeding with a temporary arterial occlusion balloon in revision total hip arthroplasty.

Purpose: Perioperative bleeding is an undesirable surgical phenomenon. An effective way of diminishing bleeding is by use of a temporary arterial occlusion balloon (TAOB) to produce regional hypotension. We analysed TAOB-related complications at our institution occurring with total hip arthroplasties between years 2000 and 2016.

Is two-stage revision surgery for infected hip arthroplasty worth the suffering, resources and results compared to one-stage?

Purpose: Periprosthetic joint infection (PJI) is the most serious complication of total hip arthroplasty. The treatment is usually revision in either 1 or 2 stages. This study analyses revision with impaction bone grafting for periprosthetic joint infection of the hip and compares 1- and 2-stage strategies.

Occult Hip Prosthetic Loosening Diagnosed by [18F] Fluoride-PET/CT.

Background: Positron emission tomography using the [18F] fluoride metabolite combined with computerized tomography (F-PET/CT) can be used to analyze the metabolic status of the periprosthetic bone after surgery for total hip arthroplasty.

Methods: To obtain normal PET referent values, 44 patients with 5 models of well-functioning hip prosthetic components were analyzed by F-PET/CT, radiography, and clinical score. Another group of patients having painful total hip arthroplasty, but whose radiography showed no conclusive signs of loosening, was analyzed by F-PET/CT scans before revision surgery.

Bone mineralisation adjacent to cemented and uncemented acetabular cups: analysis by [18F]-fluoride-PET in a randomised clinical trial.

Purpose: We present a randomised clinical trial using F-PET/CT to analyse new bone metabolic mineralisation adjacent to acetabular cups following total hip arthoplasty (THA).

Patients And Methods: THA was performed on 26 patients (26 cases) with hip OA. Patients with hip osteoarthritis (OA) were randomly assigned to operations with cemented or uncemented acetabular components.

Implant migration and bone mineral density measured simultaneously by low-dose CT scans: a 2-year study on 17 acetabular revisions with impaction bone grafting.

Background and purpose - Early postoperative implant migration predicts failure of joint replacements. Bone mineral density reflects bone quality and bone-graft incorporation. Implant migration and bone densitometry analysis usually require special equipment.

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial.

Implant loosening is the most common indication for revision surgery after total hip arthroplasty (THA). Although bone resorption around the implants plays a pivotal role in the pathophysiology of loosening, it is unknown whether potent early inhibition of osteoclasts could mitigate this process and thus reduce the need for revision surgery. We performed a randomized, double-blind, placebo-controlled phase 2 trial in 64 patients aged 35 to 65 years with unilateral osteoarthritis of the hip.

Fingerprint pattern of bone mineralisation on cemented and uncemented femoral stems: analysis by [18F]-fluoride-PET in a randomised clinical trial.

Purpose: We present a randomised clinical study using 18F-fluoride positron emission tomography/computed tomography (F-PET/CT) to analyse the osteoblastic part of bone metabolism (new bone mineralisation) in periprosthetic bone adjacent to femoral stems following total hip arthoplasty (THA) surgery. Patients with hip osteoarthritis were randomly assigned to THA surgery with cemented or uncemented femoral components.

Patients And Methods: THA was performed on 26 patients (26 cases) with hip osteoarthritis.

A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup.

Background: Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell.

Methods: We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.

A 3- to 18-Year Follow-Up of Revision Total Hip Arthroplasty With Impacted Bone Allografts and Cemented Lubinus SP II Stem. Clinical, Radiographic, and Survivorship Analysis With Comparison to the Literature.

Background: We present the first medium- to long-term follow-up of revision total hip arthroplasty using impaction bone grafting (IBG) combined with the matte and collared Lubinus SP II stem for cases of severe osteolysis and stem loosening.

Methods: Sixty-nine femoral revisions were identified for 67 patients consecutively operated with revision femoral arthroplasty using IBG and a cemented Lubinus SP II stem. The mean age was 69 years (standard deviation, 9.

The unstable total hip arthroplasty.

One of the most common causes for revision surgery following total hip arthroplasty (THA) is dislocation.Dislocation is associated with a considerable amount of suffering and risks for the patient, and extra costs for the health care system.Compared with degenerative arthritis, the dislocation rate is doubled for avascular necrosis and multiplied by three times for congenital dislocation, four for fracture, five for nonunion, malunion or a failed hip arthroplasty, and eleven times after surgery for prosthetic instability.

Femoral head fractures: hemiarthroplasty or total hip arthroplasty?

Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%.For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads.

Analysis of bone mineralization on uncemented femoral stems by [18F]-fluoride-PET: a randomized clinical study of 16 hips in 8 patients.

Purpose: We present the first study using fluoride-positron emission CT (F-PET/CT) to analyze mineralization of bone in the femur adjacent to uncemented stems following total hip arthroplasty (THA). We studied patients who were operated bilaterally for osteoarthritis with 2 different stems during the same surgical session.

Patients And Methods: THA was performed bilaterally during the same surgical session in 8 patients with bilateral osteoarthritis of the hip.

Component dissociation after closed reduction of dual mobility sockets - a report of three cases.

Dual mobility sockets have been introduced in recent years to manage cases of potential instability after hip arthroplasty, and their use is increasing in revision surgery. We present 3 cases of intra-prosthetic dissociation between the outer polyethylene liner and the femoral head after closed reduction of prosthetic dislocation.

Femoral head viability following resurfacing arthroplasty. A clinical positron emission tomography study.

Hip resurfacing (HR) carries attendant risks of avascular necrosis (AVN) and femoral neck fracture. We used fluoride positron emission tomography (PET) scans to analyze bone metabolism 2-5 years after surgery in 35 cases. Three of the patients had been clinical failures.

Bone metabolism analyzed by PET and DXA following revision THA using a distally fixed stem. A pilot study.

In a pilot study we analyzed bone remodeling using ¹⁸F-PET (positron emission tomography) scanning or DXA (dual-energy x-ray absorptiometry) in 3 patient groups, one with a loose femoral stem and 2 after revision using a modular stem (MP). In loose implants (group 1), bone formation activity compared to the contralateral healthy femur was 261 %. In the proximal part of the femur bone formation was increased by 253 % one week after revision (group 2) and did not normalize within 1 year.

Osteonecrosis following resurfacing arthroplasty.

Background And Purpose: One of the main concerns regarding resurfacing arthroplasty is the viability of the remaining part of the femoral head, and the postoperative risk of a femoral neck fracture or collapse. In contrast to radiographic methods, positron emission tomography using the radiotracer [18F]-fluoride (Fluoride-PET) enables us to visualize the viability of bone in the remaining part of the head, despite the presence of the covering metal component.

Patients And Methods: This is preliminary prospective study of 14 patients who underwent an ASR resurfacing arthroplasty.

Bone healing of severe acetabular defects after revision arthroplasty.

Background And Purpose: Healing of acetabular bone grafts may be difficult to assess in conventional radiographs. We used PET to analyze healing of morselized bone allografts, impacted in large osteolytic acetabular defects at revision arthroplasty.

Patients And Methods: 7 cases had a cup revision because of loosening, with repair of a segmental defect using a perforated, wide and thin plate.

Bone regeneration 6 years after impaction bone grafting: a PET analysis.

Background: Impacted morselized bone allograft in revision total hip arthroplasty for prosthetic loosening has gained widespread clinical use during the last decades. The clinical results are good but little is known about the bone regeneration in the graft.

Patients And Methods: 5 patients were revised with impaction of morselized frozen allograft and a cemented total hip arthroplasty (THA) due to loosening and osteolysis of a primary THA.

Migration pattern of a short femoral neck preserving stem.

Unlabelled: The CFP stem represents a short collared neck-retaining stem with very proximal metaphyseal anchoring along the calcar combined with up-to-date metallurgy. Despite theoretical advantages, the stability and clinical outcome are unknown. We prospectively measured the migration pattern of this new stem and cup.

Rapid bone and blood flow formation in impacted morselized allografts: positron emission tomography (PET) studies on allografts in 5 femoral component revisions of total hip arthroplasty.

5 patients were revised with impaction of morselized frozen allograft and a cemented total hip arthroplasty (THA) because of loosening and osteolysis of a primary hip arthroplasty. Plain film radiographs of the stems showed stable implants in all patients 15-24 months after surgery. The clinical results were good.

Impacted corticocancellous allografts and cement for femoral revision of total hip arthroplasty using Lubinus and Charnley prostheses.

Femoral revision of total hip arthroplasty using impacted morcellized allografts and a cemented Lubinus SP-II prosthesis (Waldemar Link GmbH & Co, Hamburg, Germany) or Charnley standard prosthesis (De Puy, Leeds, UK) was performed in patients with loss of bone stock grade II-IV according to the Endoclinic classification from first to eighth revision. We report the results from 57 hips in 56 patients, with a median of 64 months' follow-up. Modified Merle d'Aubigné-Postel postoperative scores increased significantly from preoperative to postoperative values for the Lubinus group and for the Charnley group.

Histology of impacted bone-graft incorporation.

We describe the histologic findings of 31 tissue samples from 21 cases in 19 different patients taken 1 to 48 months after revision arthroplasty and impaction grafting in the hip (Lubinus SP-II prosthesis Waldemar Link, Hamburg, Germany, or Charnley Elite prosthesis, Johnson & Johnson, New Brunswick, NJ) and the knee (Link Rotation Knee Waldemar Link). One month after surgery, a fibrous stroma and some newly formed woven bone were found in the graft bed. After 4 months, many of the dead trabeculae in the graft bed had layers of living bone and osteoid in all samples.